演題詳細

一般口演 / Oral Session

【E】一般口演 21 (Oral Session 21) :Hematopoietic Cell Transplantation

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日程
2013年10月11日(金)
時間
14:25 - 15:25
会場
第5会場 / Room No.5 (さっぽろ芸文館 3F 清流)
座長・司会
石山 謙 (Ken Ishiyama):1
1:Div. Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
 
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GVHD and survival after cord blood transplant for acute leukemia: Japanese vs. the U.S. populations

演題番号 : OS-1-105

鍬塚 八千代 (Yachiyo Kuwatsuka):1,2、熱田 由子 (Yoshiko Atsuta):3、Mary Horowitz:2、稲垣 二郎 (Jiro Inagaki):4、諫田 淳也 (Junya Kanda):5、加藤 剛二 (Koji Kato):6、康 勝好 (Katsuyoshi Koh):7、Mei-Jie Zhang:2、Mary Eapen:2

1:Department of Hematology and Oncology, Nagoya University, Nagoya, Japan、2:CIBMTR, Medical College of Wisconsin, Milwaukee, U.S.、3:Department of HSCT Data Management and Biostatistics, Nagoya University, Nagoya, Japan、4:Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan、5:Division of Hematology, Saitama Medical Center Jichi Medical University, Saitama, Japan、6:Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan、7:Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan

 

An earlier report observed higher acute and chronic graft-versus-host disease (GVHD) in Caucasians compared to the Japanese children after sibling bone marrow transplantation (Oh et al. 2005). To address whether racial differences are associated with GVHD rates after umbilical cord blood transplant (UCBT) we analyzed data from the CIBMTR and the JSHCT. Japanese and U.S. Caucasians receiving myeloablative single unit UCBT between 2000 and 2009, for acute leukemia in complete remission, and 16 years or younger were eligible. No Japanese received antithymocyte globulin (ATG) (n=257). Caucasians were grouped based on whether ATG was included in conditioning (n=168) or not (n=92). Median ages of Japanese and Caucasians receiving ATG were 5 years; remaining Caucasians were 8 years. The corresponding median total pre-freeze cells were 5.1, 7.4 and 5.7x107/kg. HLA mismatch status was not different. In multivariate analysis, there were no differences in risks of acute GVHD. However, compared to the Japanese, chronic GVHD was significantly higher in Caucasians without ATG (hazard ratio [HR] 2.16, p<0.001) but not for those receiving ATG. TRM was higher in Caucasian with ATG (HR 1.81, p=0.01). Higher chronic GVHD and TRM did not result in higher overall mortality rates in the U.S. The 5-year probabilities of overall survival adjusted for patient CMV serostatus and disease risk were 61% (Japanese), 51% (U.S. with ATG) and 57% (U.S. no-ATG). These data suggest higher TRM in Caucasians receiving ATG are not driven by acute or chronic GVHD, rather by differences in transplant strategies.

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